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Iowa faces a shortage of medical-grade protective equipment so severe that the state government is ordering use beyond typical manufacturer guidelines.

The new order allows health care workers to wear expired face masks and gowns, use the same equipment during multiple patient contacts and reuse single-use equipment. It also authorizes health care facilities to more quickly discharge COVID-19 patients once they stabilize.

Iowa Department of Public Health Deputy Director Sarah Reisetter acknowledged that “people are scared,” and said the state is doing everything it can to stock up on supplies. Some health care facilities have already been operating on extended-use guidelines for protective equipment, in part prompting the statewide order.

“Unfortunately, we're in a position where, like many states and countries across the globe, we are preparing for a time when we might not have enough of these supplies,” Reisetter said.

Expecting a shortage of this personal protective equipment does not reflect a predicted surge in COVID-19 cases, she said, but instead reflects the nationwide shortages of equipment. The order intends to extend the supply of PPE available in the state.

COVID-19 is the potentially fatal respiratory illness caused by the new coronavirus. PPE generally refers to items typically worn by front-line health care workers to prevent the spread of infectious diseases, including face shields and masks, isolation gowns, gloves and N95 respirators — face masks with some of the highest-rated particulate filtration.

As of Friday, another 118 people in Iowa had tested positive for coronavirus, bringing the total to 1,388 positive cases. Another two people with COVID-19 in Iowa have died, bringing the statewide total to 31.

On Tuesday, Reisetter said 22% to 23% of total positive tests belong to health care workers. Limited tests and specific guidelines on who should be tested mean they don’t provide a full picture of the virus’ spread through Iowa.

The Iowa Department of Public Health's new "shortage order" is aimed at maximizing the use of PPE and extending the state's supply.

It includes having patients use barriers other than surgical face masks to cover their mouths and noses and emphasizing the use of telemedicine to keep patients out of hospitals and clinics.

Gov. Kim Reynolds previously suspended nonessential medical and dental services to preserve PPE; this order extends that to other nonurgent procedures and appointments that would use personal protective equipment.

If health care providers still find supplies stretched thin, the directive then orders them to reuse equipment including gowns, eye protection and face masks between patients, and ignore expiration dates on some equipment. It encourages decontaminating N95 respirators via hydrogen peroxide, ultraviolet light and moist heat for reuse.

If no medical-grade items are available, the order also allows for the use of homemade masks in concert with face shields and homemade gowns that comply with IDPH guidelines.

The order extends legal immunity to health care providers acting “in good faith” to comply with the order. It is in effect until the public health disaster emergency declaration is lifted or modified.

“We understand the issuance of this order may be unsettling, but due to the global shortage of PPE supply, we have determined that now is the time to take this action,” Reisetter said.

The order is a reflection of the situation the state finds itself in, and helps make health care providers act consistently across the state, Iowa Medical Society Director of Education and Engagement Kady Reese said. Officials with medical society feel the order balances patient and provider safety, while recognizing shortage problems that need to be addressed.

"We have to be cognizant of the scenario that we're in, and how do we maintain safety with what we have, as we work toward those best practices," Reese said, calling the moment "unparalleled."

"It's, 'What can we do right now to ensure the best safety with what we have and what we work toward?'"

The lack of PPE is being felt across the state, she said. Iowa hospitals have been pleading for donations of PPE and other supplies used to fight COVID-19 for weeks. In March, UIHC made an “urgent request” for face shields.

UnityPoint Health has also regularly asked for items such as hand sanitizer and gloves. It keeps an updated list on the health system’s needs, including a call for homemade items, on its website. Homemade items are accepted, but will be used only when UnityPoint exhausts all of its medical-grade equipment.

"We recognize that as we continue through the weeks, our need for PPE is only going to increase as we start inching toward that ... peak week in Iowa," Reese said.

Reynolds said the Iowa Department of Corrections produces washable medical gowns and will soon produce 1,000 a day. She also thanked businesses for producing face shields. The IDPH has also issued guidance to Iowans wanting to sew homemade masks.

On Wednesday, it was announced that 90% of the federal personal protective equipment stockpile has been depleted as the Health and Human Services Department made its "final shipments" of N95 respirators, surgical and face masks, face shields, gowns and gloves to states fighting the disease. The remaining 10% is reserved for the protection of federal workers.

Nick Coltrain is a politics and data reporter for the Register. Reach him at ncoltrain@registermedia.com or at 515-284-8361. Your subscription makes work like this possible. Subscribe today at DesMoinesRegister.com/Deal.